1669593406 NPI number — PAOLI FIRE COMPANY

Table of content: (NPI 1669593406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669593406 NPI number — PAOLI FIRE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAOLI FIRE COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669593406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAOLI
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19301-0255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-644-7070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 DARBY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAOLI
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-644-1712
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BEATTY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-271-1120

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  02016 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 216482 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012341580001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590003039 . This is a "PALMETTO GBA-RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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